ICU Telemedicine Does Not Reduce Mortality, Length of Stay

A study published in JAMA Internal Medicine has found that implementation of a telemedicine component in intensive care units does not reduce mortality or length of stay among ICU patients.

The multi-institution study followed 6,939 patients at seven Department of Veterans Affairs hospitals in 2011-2012, about evenly split between patients who were treated in intervention ICUs (1,708 in the pre-telemed period and 1,647 in the post-telemed M period) and 3,584 treated in control ICUs during the same period. Patient demographics and comorbid illnesses were similar in the intervention and control ICUs during the pre-telemed and post-telemed periods.

The authors wrote implementation of ICU telemedicine was not associated with a significant decline in ICU, in-hospital, or 30-day mortality rates or length of stay in unadjusted or adjusted analyses.

For example, they discovered unadjusted ICU mortality in the pre-telemed vs post-telemed periods were 2.9 percent vs 2.8 percent for the intervention ICUs and 4 percent vs 3.4 percent for the control ICUs. Unadjusted 30-day mortality during the pre-telemed vs post-telemed periods were 7.7 percent vs 7.8 percent for the intervention ICUs and 12 percent vs 10.2 percent for the control ICUs.

"Evaluation of interaction terms comparing the magnitude of mortality rate change during the pre-TM and post-TM periods in the intervention and control ICUs failed to demonstrate a significant reduction in mortality rates or LOS," they wrote, concluding with "We found no evidence that the implementation of ICU TM significantly reduced mortality rates or LOS."

In an accompanying invited commentary, M. Elizabeth Wilcox, M.D., of the University Health Network in Toronto, and Jeanine P. Wiener-Kronish, M.D., of Massachusetts General Hospital, said the absence of observed benefits "may have been inevitable given the low mortality rates observed in the controls, reflecting an already high standard of care and/or simply low illness severity."

In contrast, they noted a study conducted in 56 ICUs showed both lower mortality rates and ICU and hospital length of stay in ICU telemedicine implementations. The ICU environments most likely to benefit from ICU telemedicine, they said, were those with comparably less robust infrastructure or ICU capacity strain.